HNT-AI: An Automatic Segmentation Framework for Head and Neck Primary Tumors and Lymph Nodes in FDG- PET/CT Images

Abstract

Head and neck cancer is one of the most prevalent cancers in the world. Automatic delineation of primary tumors and lymph nodes is important for cancer diagnosis and treatment. In this paper, we develop a deep learning-based model for automatic tumor segmentation, HNT-AI, using PET/CT images provided by the MICCAI 2022 Head and Neck Tumor (HECKTOR) segmentation Challenge. We investigate the effect of residual blocks, squeeze-and-excitation normalization, and grid-attention gates on the performance of 3D-UNET. We project the predicted masks on the z-axis and apply k-means clustering to reduce the number of false positive predictions. Our proposed HNT-AI segmentation framework achieves an aggregated dice score of 0.774 and 0.759 for primary tumors and lymph nodes, respectively, on the unseen external test set. Qualitative analysis of the predicted segmentation masks shows that the predicted segmentation mask tends to follow the high standardized uptake value (SUV) area on the PET scans more closely than the ground truth masks. The largest tumor volume, the larget lymph node volume, and the total number of lymph nodes derived from the segmentation proved to be potential biomarkers for recurrence-free survival with a C-index of 0.627 on the test set.